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Semin Arthritis Rheum. 2016 Oct;46(2):143-50. doi: 10.1016/j.semarthrit.2016.05.002. Epub 2016 May 18.

High prevalence of tenosynovial inflammation before onset of rheumatoid arthritis and its link to progression to RA-A combined MRI/CT study.

Author information

1
Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany.
2
Institute of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Maximilansplatz 1, D-91054 Erlangen, Germany.
3
CSD Clinica Som Diagnosticos, Parque Shopping Belém, Belém, PA, 66635-110, Brasil.
4
Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU), Ulmenweg 18, D-91054 Erlangen, Germany. Electronic address: georg.schett@uk-erlangen.de.

Abstract

OBJECTIVE:

To define the anatomic distribution of the earliest inflammatory and structural changes in individuals with anti-citrullinated protein antibody (ACPA+) positivity but no signs of arthritis.

METHODS:

ACPA+ individuals (N = 20) and healthy controls (N = 13) received simultaneous gadolinium-enhanced magnetic resonance imaging (MRI) and high-resolution peripheral quantitative computed tomography (HR-pQCT) of the hands. MRI sequences were scored for synovitis, osteitis, and bone erosions according to the RAMRIS method as well as for presence, localization, and extent of tenosynovitis. Bone erosions were validated by HR-pQCT scanning and related to the inflammatory changes found in the MRI.

RESULTS:

Tenosynovitis was the most prevalent inflammatory pathology, affecting 80% of ACPA+ individuals but none of the controls. Tenosynovitis at two or more anatomical sites was associated with later development of RA. Synovitis (65%) and osteitis (35%) were present in ACPA+ individuals as well, but at a lower frequency than tenosynovitis. MRI bone erosions were found in 65% of the individuals and additionally confirmed by HR-pQCT. Presence of MRI osteitis was the inflammatory pathology most strongly associated with bone erosions.

CONCLUSION:

Tenosynovitis is highly prevalent in ACPA+ individuals without arthritis and associated with later development of RA. Small erosions, often linked to osteitis, are also found in ACPA+ individuals without arthritis.

KEYWORDS:

ACPA; CT; Imaging; MRI; Tenosynovitis; pre-RA

[Indexed for MEDLINE]

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